Home > General OB/GYN Topics, GYN Oncology, Gynecology > Taking Care of the Dying Jehovah’s Witness

Taking Care of the Dying Jehovah’s Witness

This month I started a fellowship that predominantly involves taking care of women with cancer.  Through surgery, chemotherapy, and other medications we do our best to cure or hold back malignancies of many kinds.  In these past weeks, I have taken care of several patients who are Jehovah Witnesses, an experience that has been quite interesting.

In most cases, what religion a person subscribes to has little to no impact on their clinical outcome.  We have an exception, however, when it comes to a Jehovah’s Witness with cancer.  JHW patients to a rule will not accept blood products of any kind, which greatly limits their ability to be effectively treated for cancer.  In some cases they cannot have surgery the surgery they need is unsafe without the possibility of blood transfusion.  In some cases they cannot take chemotherapy because blood transfusion is required to survive the associated myelosuppression.  As surgery and chemotherapy are our two best treatment, they are at a major disadvantage.

When I was a resident, I had a pretty hard opinion about this.  I heard a lot of different view on the topic, but the position of one of my attendings resonated best with me.  He felt that his job as a physician was to protect the health of his patients, and that if a JHW was dying in front of him he was going to transfuse them whether they liked it or not.  He was quite clear about this upfront, and told JHW patients that if they were not happy about this they should find another doctor.  He even arranged for attending coverage for emergent issues if need be.  He felt that the preventable death of a patient was an emotional trauma he didn’t want to be exposed to, almost as if the patient, through refusal of blood, was exposing him to unnecessary emotional violence.  While this was a very hard line, I respected the boldness of  it, and that he was being true to his internal values.  I held a similar feeling for the first few years of my attendinghood, though I never had to test it until my third year out of residency.

The test came when a JHW presented to our hospital in Hawaii with severe vaginal bleeding, and had a hemoglobin of only 4 (normal being about 15).  We did everything we could medically, but she continued to bleed off an on.  She was utterly saveable with a blood transfusion and a subsequent hysterectomy.  It would have been fairly routine.  But in her case it wasn’t routine, because she would not take blood.  We tried a number of approaches, but nothing really worked.  There were so many things we could do with blood, but without it she was too unstable for us to act without killing her.  And so she slowly declined until she was in high output heart failure.  I had never seen someone’s hemoglobin drop so low, and was amazed that she didn’t actually die until she was down to 0.6, with blood so clear you could read the paper through it.  I had previously stood with my hard line attending, but being put to the test I found myself more respectful of the patient’s wishes, and helped the team care for her the best we could until her death.

Since that time I’ve taken care of a few similar patients, some of which could be saved and some not.  I was recently in a surgery where we were discussing whether or not Hespan was acceptable or not.   As my patient was bleeding I was thinking that authors of the Bible didn’t know what Hespan was, that the whole things was a bit ridiculous.  We gave the Hespan.  Another recent patient had recurrent cancer and cannot be effectively treated because of her low hemoglobin, and will eventually find her life cut very much shorter than it would have been if she took blood.

What’s interesting to me is that unlike my hardline attending, I have found very little emotional distress in these situations.  While I would love for these people to have good outcomes, I didn’t make them sick. I don’t share their religion, but I am pretty sure that robbing them of their faith and security would do far more harm to their personhood than a few pints of blood could ever heal.  Everyone must die eventually, and it seems better for them to go on their own terms than to live on in fear that they have damaged their potential in eternity.  I don’t know whether their religion has an accurate view of the long term consequences of taking blood or not.  But that doesn’t matter.  Making it matter wouldn’t be good doctoring.

There is a saying that a physician must strive to have great sympathy, but to do what they can to avoid empathy.  The distinction is lost on many.   Sympathy is when you care about how your patient is feeling, but empathy is when you feel it yourself.  Empathy, in other words, is taking it personally.  While some argue that such closeness with patients is a positive physician trait, I would argue that these people haven’t well considered the difference between sympathy and empathy, and the results of the execution of each.   Patients appreciate their physician’s sympathy, but in the end depend on the physician’s lack of empathy.  Without that, it is very difficult for the physician for the physician to give objective medical advice, and if need be to respect a patient’s right to refuse that advice.  While it saddens me to some extent that a JHW might die for lack of blood, I feel enough sympathy for their decision to place their religious belief above their self preservation that I can ignore my empathic need for them to take blood.  Its not my life after all.

I think back to my attending that had the hard line, and think perhaps he had a little too much of his own ego involved.  He was deeply invested in his patient’s outcomes, and therefore would be personally injured if his patient died a death that he thought was preventable.  I used to see this as noble, but in the end it was not the most effective physicianhood.  His patients would have been better served if it he didn’t take their outcome so personally.

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  1. September 4, 2011 at 1:24 pm

    I’m a birth doula, not a physician, but I think your philosophy applies to my work as well. I strive to meet my clients’ needs to the best of my ability, and sometimes that means setting my needs aside.

    • September 7, 2011 at 5:46 am

      Jehovah’s Witnesses blood transfusion confusion.
      Estimates range from 100,000 to 250,000 JW including countless children that have perished since the 1940s when the no blood doctrine was enforced.
      Simple fact-The Bible does not prohibit Blood transfusions.If you are bleeding to death it is more dangerous to refuse a blood transfusions than to take one.
      Bloodless surgeries are great if they can be elective.1/3rd of all trauma deaths are from blood loss.

      1) Jehovah’s Witness do use many parts ‘fractions’ components of blood,so if it’s ‘sacred’ to God why the hypocritical contradiction flip-flop?

      2) They use blood collections that are donated by Red Cross and others but don’t donate back,more hypocrisy.

      3) The Watchtower promotes and praises bloodless elective surgeries,this is a great advancement indeed, it’s no good to me if I am bleeding to death from a car crash and lose much of my blood volume and need EMERGENCY blood transfusion

      The Watchtower society leaders of Jehovah’s Witnesses will not allow a follower to pre store their OWN blood called autologous blood,yet allows the transfusion of so-called Hemopure made from Bovine cow blood.

      Danny Haszard
      http://www.ajwrb.org/basics/abstain.shtml

    • Jay
      September 8, 2011 at 6:52 am

      Jennifer,
      You’re a truly decent person. Most get so emotionally involved over issues they don’t understand or don’t wish to understand that they forget their obligation to the patient and the trauma they are going through.
      Treating the whole individual physically and spiritually is the best treatment of all.
      Thank you for your kindness.

      It is a shame that the Danny guy runs all over the net spreading falsehoods about the organization he was kicked out of. Sour grape syndrome.

      • September 8, 2011 at 8:10 am

        Hello,you just made a classic personal attack on Danny Haszard .

        Now,what part of my post is ‘falsehoods’ please elaborate?

        Danny Haszard http://www.dannyhaszard.com

  2. September 4, 2011 at 1:58 pm

    And I am a JW, not a physician, but appreciate very much the thought you’ve given this subject. I can well appreciate the frustration of a doctor upon discovering his preferred method of treatment, perhaps his only method of treatment, is categorically rejected for reasons he neither understands nor agrees with.

    I don’t share their religion, but I am pretty sure that robbing them of their faith and security would do far more harm to their personhood than a few pints of blood could ever heal. Everyone must die eventually, and it seems better for them to go on their own terms…

    Every population of Jehovah’s Witnesses maintains a Hospital Liaison Committee, which serves to connect local doctors with whatever bloodless resources may exist locally, and discuss whether they are applicable. Even when they are, bloodless medicine is a specialty, and one can hardly expect all doctors to specialize. We simply appreciate it when doctors attempt to work with our beliefs, rather than trod over them.

    • September 4, 2011 at 2:04 pm

      Tom – its been my experience that many JHW have views on ‘bloodless’ medicine or ‘bloodless’ surgery that is not in concert with reality. I was given a video by one patient I operated on that was filled with a lot of non-truths told by non-surgeons.

      There is no such thing as ‘bloodless’ surgery as an actual different technique than ordinary surgery. Its just good surgical technique, which will lead to less blood loss. One would hope that a surgeon would practice ‘bloodless’ surgery on every patient, JHW or not. Nonetheless, some surgeries are near impossible to perform without significant blood loss, such as a liver resection or an ovarian cancer debulking. Anything that involves cutting through vascular tissue planes is typically going to lead to blood loss, and even with the best technique that’s hard to get away from. Fortunately, people that are not already profoundly anemic can handle that.

      I think when we are faced with JHW patients who lose a lot of blood we’re often surprised at the resiliency of the human body in the face of profound anemia. People who we thought might die do not, and eventually recover their hemoglobin levels, albeit with a prolonged period of feeling terrible and having little energy.

      The Cell Saver is a useful tool, and we do use that in surgery when we can. There is some controversy over whether one should use it in a cancer case, and thus potentially transfuse tumor cells back into the patient, but if blood is truly needed it is better than nothing I think.

      Another useful tool, though not applicable to all surgery, is the use of robotic assisted laparoscopy. With the robot, we have such great vision of the tissues that operating without any blood loss becomes much easier. I have done several hysterectomies for JHW patients with large fibroid uteri, and in all cases was able to lose far less blood than one would have in an open case.

    • September 8, 2011 at 5:31 pm

      The car crash victim for whom volume expanders will do nothing much, the mother who ruptures during labor and needs an emergency c-section but is in danger of bleeding to death, etc. You can’t say that blood is never medically necessary.

      And to say that the bible says we can’t take blood intravenously is a gross misrepresentation of scripture. (Mark 3:4) The Jesus asked them, “Which is lawful on the Sabbath: to do good or to do evil, to save life or to kill?”
      Jehovah’s Witnesses is a cult based on rules. God is about life and preserving it, because he is its author.

  3. September 4, 2011 at 2:02 pm

    Somehow my return link did not activate. So it is here:

    http://tinyurl.com/c3ewjp

  4. September 4, 2011 at 2:09 pm

    Jennifer- I am also a doula, and agree completely. It is a struggle at some moments, but we must always leave “ourselves” at the door and enter as support with no opinion or agenda. Our goal as care providers should always be to provide compitent care & respect our clients wishes. Enjoyed the post. Thank you!

  5. September 4, 2011 at 2:25 pm

    I cared for a Jehovah’s witness as she died of post partum hemorrhage (when I was an L&D nurse). I was the only one with her for her last hour. As she continued to bleed and the residents and attendings came to talk to her, it became clear that she would likely die. Being the brazen young pup that I am, I asked her “you realize you will probably die without a transfusion, don’t you?” The look on her face I can remember to this day….she was completely at peace, despite leaving a newborn and 2 other children. She answered quietly “I know that” and gently touched my arm. She believed in the kingdom of heaven and was so happy to be getting to go there.

    For me, there was no peace. My dear father committed suicide when I was 21, and it hit too close to home for me.

    Her death was so easily preventable (in all likelihood). This was a high-risk unit where women recovered from DIC and amniotic fluid embolisms and high spinals all the time. Maternal deaths were exceedingly rare. I had seen women in much worse shape go on to recover.

    On top of it, the team of doctors and nurses worked they butts off for hours, trying to save her. I saw physicians who were normally quite reserved break down crying in the OR. The OB brought the husband into the OR and begged to please be allowed to save her life and when the husband said no and left, the OB just started sobbing.

    It was an emotionally devastating day for all involved, but I think I took it the worst because of my father’s suicide. Shortly there after I became a CNM and had a policy (agreed to by my colleagues) that I would not care for a JW who was hemorrhaging; some one else would come in and take over. I also discussed this with every JW client and told them why. They seemed to understand. I figured they had every right to refuse treatment, and I had the right to refuse to be a witness.

    It took a good 10 years for me to get over my personal feelings and be able to embrace pretty much exactly what you have so eloquently stated here. It’s not about me and I no longer shy away from JWs or shudder when I see it in a chart.

    • November 14, 2011 at 2:29 pm

      Obviously I wouldn’t want to coerce someone to act against their beliefs, but what greater good could possibly come of leaving your three small children without their mother? She was looking forward to Heaven, but I almost want to call that selfish to consciously choose your eternal reward when you could choose to stay alive and care for your babies. I just have a hard time believing in a god that would require such a thing.

      • Little Me
        November 15, 2011 at 4:06 am

        Agreed Lindsey. There is no way any loving god asks you to leave behind your own children. Any decree that says that I must refuse a very simple life-saving measure and accept death, leaving behind my family is one that is borne of either ignorance or malice.

        And the husband walking away… as his wife slowly bleeds to death. Unbelievable.

        I can tell I could never practice medicine. I’m unable to process how you could leave behind your children.

  6. September 4, 2011 at 2:26 pm

    Oops, I was the only one with her for her last *conscious* hour.

  7. September 4, 2011 at 2:52 pm

    As the former president of a med-mal insurance company for ob/gyns, I’d like to offer a somewhat broader perspective on patient choice/parent choice.

    There have been several (!) cases in my former company in which a patient, well-informed about the problem of birthing and raising a Down’s syndrome child (for example), clearly chooses to (sometimes) refuse amniocentesis (or PUBS or CVS), and then carries the potentially genetically problemed child to term. Sometimes during the 3rd to 6th month postnatally, the parents realize that the economic issues (about 10X the usual cost of child-rearing) are only the beginning of the catastrophic burden represented by a problem child of this sort.

    They then sue the physician….not untypically, for very large sums, and such sums are typically awarded by juries (if such cases ever come to jury trial. Most defense attorneys advise against going through a jury trial, as losing is very likely given the sympathy of the jury.) So…even though the record is clear, and even though the parents were warned, and even though the counseling, testing, and informing were complete and lucid, nonetheless the physician is sued…with the parent(s) claiming lack of information, or poor guidance, or informational failure (or overload). Judges will not blink when a jury awards $5, $10 or even $50 milion dollars. Why? Well, if the physician and the insurer do not pay, the institutions which pay the judges will pay. Judges usually know on which side their bread is buttered.

    The average ob/gyn leaves off delivering babies at the age of 46. Forty per cent of all ob/gyns are sued during their residencies. Ob/gyn premiums are the highest of almost any specialty.

    What’s wrong with this picture?

    We live in a world where people at all levels, in all frameworks, in all walks of life, are disenchanted with the wisdom of accepting the consequences of one’s actions, and instead abnegate personal responsibility. “Mea culpa” just isn’t comme il faut these days.

    Such attitudes are endemic. I pray that your children are not so constituted, for if they are, sooner or later they will sue the physician who successfully helps award them with a new young human being for whom to care.

    What’s remarkable about the JHWs described here earlier, is that they willingly take 100% responsibility for their own actions. This is so admirable. The world needs more folks like this. While they may make some physicians squirm (or worse), they enter and leave the world with an acute sense of personal integrity that deserves the highest admiration.

    • The Deranged Housewife
      September 5, 2011 at 6:27 am

      “There have been several (!) cases in my former company in which a patient, well-informed about the problem of birthing and raising a Down’s syndrome child (for example), clearly chooses to (sometimes) refuse amniocentesis (or PUBS or CVS), and then carries the potentially genetically problemed child to term. Sometimes during the 3rd to 6th month postnatally, the parents realize that the economic issues (about 10X the usual cost of child-rearing) are only the beginning of the catastrophic burden represented by a problem child of this sort.”

      I kind of find this part of your comment pretty disgusting. Sure, I don’t disagree that some families sue, but how many? Considering the vast majority of DS pregnancies – perhaps some of which are suspected but aren’t even confirmed – are terminated, I’m not sure this is as big a problem as you purport it to be. Granted, I’m not in the insurance field, but I do know a DS family and many others who say it’s a special kind of blessing to raise a child – who IS a person, you know – with Downs. You act like they’re a parasite, and that’s really sad.

      As a woman who has labored and produced three children, I and many like me don’t have a hard time seeing why OBs are often sued. Perhaps because of trial-happy lawyers; maybe those in search of the “perfect” baby and are angry that that didn’t come to fruition. But when I study (and experience) some of the crazy unnecessary interventions pregnant and laboring women are exposed to – it’s not a wonder. Too bad more of them don’t have a respect for the laboring mom’s wishes and not do something she refuses, or respect her personal space and only do them when they’re truly necessary, instead of treating every pregnant patient like she has an illness.

    • September 8, 2011 at 5:38 pm

      This sounds like a Jehovah’s Witnesses shill posting.

      The fact is the Watchtower organization is highly litigious and will sue for damages at the drop of a hat.

      Just like Scientology.

      Just recently in the news several cases of them SUING doctors…

      ..

      • MommyToBe
        December 2, 2011 at 10:34 am

        Perhaps you could post the links or at least the bylines of the stories of Jehovah’s witnesses suing somebody. I am not one of Jehovah’s witnesses but I know many quite well and going after money that they didn’t earn is not part of their philosophy of belief.

  8. September 4, 2011 at 6:15 pm

    Excellent thoughts, I completely agree!

  9. Caroline
    September 4, 2011 at 6:45 pm

    Interesting post. However, I’m curious to know what your perspective would be if the patient were a child and it was the child’s parents who were refusing the transfusion on the child’s behalf.

    Also, the sympathy/empathy argument can run the other way. I might also empathise with their need to place their faith above saving their own life, even if my religion is not the same. I’m not sure that’s a good enough argument for respecting their choice.

    In any event, much food for thought!

  10. Marianne
    September 4, 2011 at 10:47 pm

    I’m very happy to read this post and wish I could be your patient. While I’m an atheist I think it’s important that everybody’s wisehes (within reason) are respected.

    I agree with the comment about taking responsibility for ours decisions as patients, though, as doctors need to take theirs.

  11. September 5, 2011 at 1:12 am

    Thanks for your thoughts. As a Lamaze Childbirth Educator, I have to remember this, too, in my classes. (Obviously, the situations you’re in are much more dramatic!) It’s about the mom and partner, not my hopes/fears/expectations for them.

  12. sara r.
    September 5, 2011 at 10:46 am

    I am also one of Jehovah’s Witnesses, and I really appreciate your thoughts. I too personally know living brothers and sisters who were told by physicians that they WOULD die if they didn’t accept a blood transfusion, yet here they are, still with us. Yet, even if they had died, they would be confident that because they followed the command in the Bible to abstain from blood, that they would be safe in the memory of the Creator and giver of life. This is why Jehovah’s Witnesses can make the determination that they do.

    Recently a friend of my mother’s who had an emergency hysterectomy was told by her surgeon 5 days AFTER the surgery, when she had started to recover and was stable, that she was still going to die because she had refused the transfusion! What was the purpose of this? To depress her into fulfilling his prediction? 2 months later she is home and doing well.

    I think also that there is a difference in perspective- the lack of a blood transfusion is not what kills the patient, but the circumstance that led to the blood loss. At that point, the decisions regarding treatment should be the patients’ to make. If I had was diagnosed with cancer, I would not accept conventional treatment, and that decision should be mine to make, regardless of how popular or unpopular it is.

  13. Carolyn Neal
    September 6, 2011 at 7:13 am

    This is very beautifully conveyed. Your reasoning powers and sense of humanity are reflected and how wonderful it is to read of your journey with your patients. As a Witness of Jehovah I have not had to face this kind of health issue or life/death decision as yet. However, I would hope under such circumstances that I would hold firm to the track of bloodless surgery and medicine. The reason we reject transfusions is God’s mandate to the Jews to refrain from consuming blood, indicating that the “life force” is in the blood, that it is sacred, and it should not be co-mingled. We all know that lives can be extended for many who take transfusions, but we also know that this life is short anyway and we are looking to a future promise of a life free of corruption, diseases, death. Meanwhile we all seek the highest quality health care available, but we want it free of transfusions. Fortunately, that seems to be in alignment with the new frontiers in medicine — it is cleaner surgery, recovery times are faster, and there are fewer side effects. Hospitals and physicians throughout the U.S. and around the world are establishing tranfusion-free surgery centers and TFMS personal practices. So our long effort, which is now being accepted by a large percentage of mainstream patients as the healthful alternative, is now coming to fruition.

    Again, I enjoyed reading of your personal experiences with your patients and you were affected over time.

    Kindest regards.

  14. Kenneth
    September 6, 2011 at 7:52 am

    What a religion! I have nothing good to say about being a Jehovah Witness. I will say that I am very familiar with the religion. They have several beliefs that for me I was not able to comprehend. Yes I was raised in the religion at a young age. At the age of 5 until I was able to say to my parents I choose not to attend the services, was very traumatic for me. Not recieving blood was one of them. Faith is about believing in a higher power. Being an adult know I realize GOD, Jehovah, Allah, or what ever you want to call him, we have to think he provided others (you can call them diciples (doctors, therapists)) that he placed on earth to help his followers. 145,000; cant attend other faith institutions, cant celebrate holidays, cant associate with disfellowshiped members, etc. Sounds more like a cult to me!

    • sara r.
      September 7, 2011 at 6:18 am

      I’m sure you’re the first 5 year old who didn’t want to go to worship services…haha. Sorry you were so “traumatized” at such a young age by being asked to sit somewhere and pay attention. geez.

      Seems that you missed that actual point of the article, also.

  15. Kenneth
    September 7, 2011 at 8:09 am

    @Sara…I believe I was on point with the actual point of the article. The point of the article is how skewed the thinking of JW’s are. I am very familiar with their doctrine, from blood use to having friends outside of the cult…I mean religion. And for your information I was very attentive, why do you think I frown so on the cult…I mean religion.

    • Emma
      September 20, 2011 at 12:52 pm

      Kenneth, you ARE SOO RIGHT!

  16. Jay
    September 8, 2011 at 8:55 am

    It is interesting how some can estimate 400 witnesses die a year or a quarter million have died because of not taking blood.
    These are bogus stats without any data to back them up.
    This is the kind of mis-information those who oppose Jehovah’s Witnesses latch on to to make their cases. To bad it is all false.

    Where is the DATA to back up the claims ? Nowhere !

    Sad that such a nice article had to be tainted with false comments.

  17. Jay
    September 8, 2011 at 8:57 am

    Danny Haszard :
    Hello,you just made a classic personal attack on Danny Haszard .
    Now,what part of my post is ‘falsehoods’ please elaborate?
    Danny Haszard http://www.dannyhaszard.com

    Any personal attack is regretted.

  18. September 8, 2011 at 5:19 pm

    I have been standing back and just reading, but…. keep it civil guys.

    Jay – I don’t find 400 witnesses dying a year from not taking blood to be hard to believe at all. I’ve had three JHW witness patients who did or will die in my care in the last six years from transfusion saveable conditions, and I’m just one surgeon. If the number is actually 400 across the entire country for each year, it actually sounds too low to me. If you (Jay) have an actual source of how many JHWs die each year, please post it. It certainly isn’t 0. To be honest, I think its a little hypocritical for you to attack that stat because no source was posted, without providing an alternate and better sourced stat yourself.

    Kenneth – I don’t think you actually got the point of my article. Maybe read it again. I am not JHW, but being judgemental of their beliefs would impair my ability to be a good physician to a JHW patient.

    The idea of “bloodless surgery” and “bloodless surgery centers” is really a marketing idea. Surgery done with proper technique will lead to as little blood loss as is possible for the case. There is no special technique that will lead to zero blood loss. Bloodless surgery just means you have decided that you aren’t going to transfuse blood for any reason. As such, if one expects a lot of blood loss one might recycle a patient’s own blood through a Cell Saver.

    If one chooses to never transfuse blood, one finds that patients will tolerate very low hemoglobins without dying. That doesn’t mean that they will feel well. A person with a hemoglobin of 4 feels terrible for a long time and has no excercise tolerance until their blood count rises, which can take many weeks. The patient will feel better instantly after a blood transfusion. The tranfusion wasn’t life saving, but it improve the patient’s quality of life dramatically.

    If a patient is actually bleeding out from an acute trauma or surgery, blood certainly is life saving. If a person is losing a lot of blood quickly, they need volume to keep their blood pressure up and their organs perfused. A certain amount of this can be done with non-blood fluids, but these fluids do not carry oxygen, so at some point in blood loss blood must be replaced. As physicians we choose not to dangle our patient’s lives out over the cliff. We prefer to keep them safe. Sometimes that means transfusing someone who probably would have survived without the transfusion. We can’t always tell though, so we keep them safe.

    N Fogelson

  19. Jay
    September 9, 2011 at 2:34 am

    Witnesses are very appreciative of the care and concern given to us by the medical profession especially in light of our Biblical stand on blood. In recent years there seems to be less concern about blood loss compared to 40 to 50 years ago. I believe new techniques and machines have lessened the burden associated with trauma and blood loss.

    It is true, in certain instances, that a transfusion is probably the only course in saving a life. But ours is a religious belief as much as the early Christians would not save their lives by offering just a pinch of incense to Caesar.

    As to the 400 deaths a year, no such statistics are available but that figure seems to be bandied about as though it were fact. In my 50 years of association with JWs, I can recall just a handful of instances where a lack of blood appeared to be the contributing factor in someone’s death. That news travels fast and wide in the JW community.

    There is some interesting information on this subject at :
    http://jw-media.org/aboutjw/medical.htm.

    Be assured “good physicians” like yourself are highly spoken of in our community.
    Thank you for your reply.

  20. September 9, 2011 at 11:38 am

    “What’s interesting to me is that unlike my hardline attending, I have found very little emotional distress in these situations. While I would love for these people to have good outcomes, I didn’t make them sick. I don’t share their religion, but I am pretty sure that robbing them of their faith and security would do far more harm to their personhood than a few pints of blood could ever heal. Everyone must die eventually, and it seems better for them to go on their own terms than to live on in fear that they have damaged their potential in eternity. I don’t know whether their religion has an accurate view of the long term consequences of taking blood or not. But that doesn’t matter. Making it matter wouldn’t be good doctoring.”

    As a philosopher and as a doula–and as an ever-potential recipient of medical care, for that matter–I cannot express to you how much I appreciate what you express in this paragraph. This sort of perspective *is* part of what makes a good doctor a good doctor. Or even a great doctor.

  21. Kenneth
    September 21, 2011 at 3:54 am

    Hey doc miss you here. Doc I understood what you were stating in your article. Medically what can you do when a patient refuses medical treatment due to religous beliefs. Make them as comfortable until they pass. Having been part of that cult…I’m religion I am fully aware of how they roll (doctrine). I have seen so much negative from this cult…I mean religion that yess it has skewed my thoughts of them.
    @Kristen…This cult…I mean religion is not any different from any other. They sin, they lie, and they try to make points of things that they frown upon once it becomes public.

    • sara r.
      September 23, 2011 at 10:06 am

      I think that of anyone, you are coming across as the most negative one here.

      Everyone else’s comments are very interesting; thanks for the narrative.

  22. Jay
    September 23, 2011 at 10:30 am

    I still can NOT find any stats on 100,000 JWs who died for not taking blood.
    Just didn’t happen I guess.

  23. Tod Aeby
    October 19, 2011 at 9:15 pm

    Hey Nick, nice blog. I’m following now. Keep posting…

  24. October 26, 2011 at 9:56 am

    An eye-opening blog. Loved the explanation between empathy and sympathy. Thanks for this.

  25. October 26, 2011 at 3:27 pm

    For all the talk of empathy and personhood I wonder if the writer kind of likes treating terminal without blood transfusion patients. Take the comment about arguing whether Hespan is biblically approved seems ridiculous. If she was so sympathetic to the patients personhood, or even treating the patient as well as possible without a transfusion, you’d think she would take that pretty seriously.

    Consider the intensity and effort required to treat a patient, sympathetically but without empathy, and the uncertainty about the outcome. Even non-JHW’s die with the best treatment, but when the patient refuses a life-saving procedure the uncertainty and responsibility of the doctor dissappears. You go from a doctor attempting to get the best outcome, to a hospice nurse waiting for a bed to open up.

    At the weekly Morbidity and Mortality meeting (where doc’s discuss deaths and whether any mistakes were made) you can be sure no one is going to find fault with your treatment because you can’t help those who won’t help themselves. She ran out of blood, what can you do? JHW’s…Am’I’right?

    Even if that’s not the thought process, or the writer doesn’t want to admit it, I doubt its an unwelcome reprieve from the usual pressures of the job.

    And, personally, I think the attending’s position, not to the exclusion of the writer’s, was perfectly reasonable. Empathetic or not, I respect his dedication to the Hippocratic Oath and I can see his point of view in that saving a life, despite a religious objection and the attendant damage to personhood, can fairly be considered a lesser harm (especially if you don’t share their belief in an afterlife and whatever). I wonder why these doctors even continue to treat patients refusing necessary blood transfusions in a hospital setting after its apparent that they will die; at that point wouldn’t the best thing be Hospice care?

  26. Lawrence M. Slocki
    October 27, 2011 at 10:34 pm

    Has anyone encountered a Jehovah Witness obstetric patient who refused Rhogam? In more than 30 years of obstetric practice I have not, although it perplexes me why it is not refused, at least on occasion. The Bible seems to have at least as many prohibitions against coitus outside marriage as it (purportedly) has that could be remotely construed as prohibiting blood transfusions. The former do not seem to be as assiduously followed

  27. November 14, 2011 at 2:31 pm

    I don’t really know a lot about the religious reasons for not accepting blood, except that it would compromise one’s adherence to the Bible. What if a medical provider gave a transfusion without the JW patient’s consent? Is that still breaking the rule, in God’s eyes?

    • November 14, 2011 at 4:19 pm

      When it comes to religion, its all up to the people in charge to decide what it all means. JHWs seem to adhere to the written doctrine of their church, which spells out the official interpretation of the related biblical passages pretty clearly.

      The bizarre thing to me is that JHW do not believe in a soul or afterlife, so I’m not sure why such things would matter…… or at least says the little leaflets I see lying around various places.

  28. January 3, 2012 at 6:26 am

    The bizarre thing to me is that JHW do not believe in a soul or afterlife

    Yes….and no. (or no…and yes?)

    We do believe in a resurrection. One can’t really have it both ways….if one believes, upon death, you go straight to heaven or (gulp) hell, what need is there for a resurrection? One has never actually ‘died.’

    So our view of the resurrection is as found in Paul’s words: “and I have hope toward God….that there is going to be a resurrection of both the righteous and the unrighteous (Acts 24:15) in which it is spoken of as a future event, not some routine process which has gone on since the beginning of time.

    This is a resurrection (by and large) to the future earth as it will be when ruled over by God’s kingdom, rather than the present hodgepodge of squabbling human gov’ts. We view that God created humans and put them on earth. He didn’t put them there because he wanted them somewhere else. In the meantime, the dead are nonexistant, as if ‘asleep.’ (see Jesus’ apt metaphor in John chapt 11)

    As to soul, we don’t maintain that man has a soul. We maintain that he a soul, as in how we may say that “not a soul was present.” The Bible’s first mention of ‘soul’ is found at Gen 2:7….”the LORD God formed man of the dust of the ground and breathed into his nostrils the breath of life: and the man became a living soul.” (KJV) He became one, he was not given one. (You became a doctor. You were not given a doctor) Thus, when a person dies, their soul dies, since it is essentially synonymous.

    Many modern translations, perhaps recognizing that such a translation of soul runs counter to their doctrine of immortal soul, have instead translated Gen 2:7 to read ‘man’ or ‘being,’ but the Hebrew word is nephesh, a word they eslewhere translate as ‘soul.’

    Hope this helps. Quite a run you’ve gotten out of this post, Doc, isn’t it? Bet you didn’t foresee it. (and no, I haven’t lurked the whole time. But I do get hits from my original comment now and again, so I come over to see how things are progressing) Good for you.

  29. Becca
    January 28, 2012 at 11:15 pm

    This may be opening a can of worms, but I just have to bring it up…
    What about the children and infants? I know as an OB you don’t have to deal with that realm, but after your babies are born some come to NICU, where in some cases transfusions are necessary for life saving measures. Should a parents right to choose be imposed on their newborn? Or in pediatrics when we have a deathly ill child or a trauma? Should their parents choose life or death for them?

  30. March 29, 2012 at 11:02 pm

    As to Danny Hazzards list of falsehoods,

    “No.2 They use blood collections that are donated by Red Cross and others but don’t donate back,more hypocrisy.”

    Come again. How do they USE blood collection without using blood. How does a person who refused blood deplete the Red Cross banks for blood.
    The point it they dont take it?
    Maybe I am reading this wrong.

  31. November 18, 2012 at 11:12 pm

    lost both my parents because of the no blood transfussion and their faith. It was a very sad thing to deal with. My mothersuffered for 8 months. 6 months before she died she had major surgery with hemo of 2.6. and surrvived but did 6 months later with hemo below 1

  32. November 18, 2012 at 11:21 pm

    Thats’she died 6 months after the surgery because of no blood, I do beleive she had herdatery hemochromatosis. she she was a derect decendant of luerr jacobson von kurkyndall of scandinavia duitch.her father was kurkendall as was she.the celtic curse and iron overload.

  33. November 18, 2012 at 11:31 pm

    my fathers 7 generations grandfather on his mothers side on her mothers side, heis last name was Groutte. he came over on a ship from mersilles franch to fight in the revelotion, and stayed . so my father had a chanch to have the same genes.he also died of severe health and died.

  34. November 18, 2012 at 11:40 pm

    i have inherited the same severe symtoms. started getting very ill in 1990, since i had a hyterectomie when i was 26. i have searched for help since 2004 now because no doctor knows what to do.I now have a swollen liver,ascites,ruster skin spots ,heart problems,endoctorin, etc.

  35. November 18, 2012 at 11:50 pm

    yes many die of blood loss and undiagnoised illnesses and i miss them very much. I also loved and respected their wishes. its thier right.it can take 20 years to get a diagnois for H.Heomochromatois. I am ordering a personal gene test. to take to a specialistthis time. i just pray and don’t judge.

  36. November 18, 2012 at 11:58 pm

    my son at the age of 23 became severly ill with all the same symtoms, now is is 26 and i worry about him.but when i get my gene DNA test i will have results in 7 days. do not have to wait to find a doctor that knows to test for this so he may have a better chance of survival.

  37. obdoc
    November 24, 2012 at 7:48 am

    many j.w.’s don’t believe doctors when we say you need blood. this is because we say people need blood when we think there is a chance of death not a certainty. that’s how the illussion of alternatives perpeuates itself. there are much fewer times (but they do exist) when we know someone is going to die without blood. in this case i would find it difficult or impossible to stand by and watch someone die. the one thing doctors have learned from j.w’s is that we transfused far too many people in the 70’s and 80’s and many people suffered harm and death.

  38. A heartbroken mom
    May 23, 2013 at 6:57 pm

    This is a devastating tragedy! Hundreds of thousand of people dying for false doctrine and a false “christian” religion. If any governing body caused liable death to a collective group of 100s of thousands, the world world world take notice and most likely call it out for the genocide that it is. It is unconscionable that we view each persons death as “a death” because it desensitizes the mass murder being perpetuated by a collective “governing” body of mortal men. The truth about Jehovah’s witnesses’ governing body is that they exploit the congregations love of God into a conditioned response of fear and unworthiness of God’s acceptance if they disobey the commandments of the governing body. If the governing body upheld the laws of God, then they would not cause a result of imminent direct death which is by definition murder. To all those of you faithful witnesses, please know that God loves you and gave you life so that you could live, he gave you free will so that you could make your own decisions and that He knows and sees the love you have for him in your heart. it is my opinion that The Watchtower Society is based on an elitist group of senseless sectarian, alchemist Enotchians who substitute the phrase Je (god) Hova 1943 (ruiener, or disaster) “Jehovah God” in text where they really mean Satan which is why they changed the doctrine from John 1:1 from saying “In the beginning was the Word, and the Word was with God, and the Word was God.” to “In the beginning was the Word, and the Word was with God, and the Word was a god.” The entire doctrine is based on ancient Jewish and Egyptian writings that incorporate the polytheistic gods of pagan mythology into the religious doctrine of the one and only God that the world receives through the Septuagint and Holy Bible.
    I mean no disrespect to the God loving people that believe the Watchtower teachings because they are of pure heart and truly believe that they following the will and teachings of God, how could anyone with a heart and conscious morality be so extremely and intentionally deceptive, most human beings are just not that evil. Additionally, one would need to spend a great many hours researching and studying the following topics:

    The Pentateuch
    The book of Enoch
    The Tetragrammatons’
    Enochian Magic
    Canaanites & Kenites (Baltic)
    exile of demons, Isrel and Canaanites
    Zionist
    Watchtower Rituals
    Religious Alchemy
    Royal Society
    Sectarianism
    Baal
    Skull & Bones Society
    Russell Trust
    13 Bloodlines
    Masonic Society
    Subliminal WT images
    Awake in religious context

    Awake name of WT magazine and the sin of Eve (Eve’s tempter Satan fooled her by offering to show her all the knowledge that God was keeping from her. The Watchtower does exactly the same thing, they slander the Orthodox/Catholic churches and teach that the doctrines in those churches have been altered and then they introduce the writings that were rejected by the original Synod assembly and kept out of the Bible as not to taint them with heresy and false gods and demons. The church does not teach to polytheism or magik craft and it certainly does not teach to slander God by reducing Him to a god with the name Je Hovah which literally means god of disaster or ruin. The Watchtower Governs by causing fear and anxiety through restricting each individuals direct connection and God given right to have a personal relationship with God. Religious alchemy inserts that only a select number of watchers can evoke and communicate with the spirits through mastering people who believe that they are following teachers leading you into the light, you are not. They are deceivers who call you Christians but teach you doctrine opposite the commandments of Gods word building failure into the design by anti-christ doctrine. You don’t need their book of reason, God gave you a heart, soul, mind and conscious ,rely on those and only those and you will find the truth for yourselves. God is God in the scriptures, “je hovah god” is anything but. So please, before you give up your life for your love of God because you are told that is what He wills, find out who it is that is speaking for Him. God will speak directly to your heart, when you hear the kind, gentle and loving voice of reason encouraging you from inside, that is the voice of God, he doesn’t need translators and couriers he has a direct line to you which he put there himself, you just need to listen for it. I hope I have been able to leave you with a sense of peace and I prey that you find yourself following the light that God is shinning on you, you are a child of God now remember God’s 1st commandment, this applies to your union with Him as well. Live, God created everything including the blessed brothers and sisters graced by Him in the medical field. It is by God’s grace that those people and options of medical care find their way to you. I wish you well.

  39. A heartbroken mom
    May 23, 2013 at 8:12 pm

    Hi again,
    About this mention, I would like to offer an explanation as food for thought, your own consciousness will prevail or course.
    .
    The Bible’s first mention of ‘soul’ is found at Gen 2:7….”the LORD God formed man of the dust of the ground and breathed into his nostrils the breath of life: and the man became a living soul.” (KJV) He became one, he was not given one. (You became a doctor. You were not given a doctor) Thus, when a person dies, their soul dies, since it is essentially synonymous.
    Many modern translations, perhaps recognizing that such a translation of soul runs counter to their doctrine of immortal soul, have instead translated Gen 2:7 to read ‘man’ or ‘being,’ but the Hebrew word is nephesh, a word they eslewhere translate as ‘soul.’

    Sorry to add even more, but I just want to point something out about the reference to Gen 2.7…when God created Adam, he did so from the earth, Adam being of the earh was important to connect humans with all creation, however all created from the earth are creatures, except humans are not creatures, we are children of God our Father, and thus not the same at all as creatures. When God breathed into Adams nostrils, he gave Adam “life” different than “soul”. We live not only because of God but also as part of God, God always lives and thus we will also always live as we are an extension of him, this is why our purpose on earth is to learn to become more like him, we aspire towards His likeness, this is called our journey towards theosis. We understand we will never be Gods ourselves, of course, however we are all part of God making us want to fulfill our “god ness”. If you are at all interested in the original greek teachings of the bible, especially the New Testament, then I would welcome you to learn about Eastern Orthodox Christianity, we have preserved the original text and teachings of Christ back to the first practices and recordings of scripture and service and have maintained their authenticity since before the first Church at Pentecost. The Bible teaches that when we die a physical death, our physical body sleeps and our soul goes back to heaven to be with our Father. Upon judgment day (the second coming of Christ) our physical bodies are recreated (from our original body) and we are resurrected in totality, just as Christ was. Christ’s death and resurrection was the living example of what will happen to us when we die. The issue with the doctrine is that you would have to accept that Jesus Christ is God our Father in the human form and nothing less. he was the second Adam and the only living human that has never sinned, this is important to correct the sin of Adam and Eve and to triumph over evil which can only be done through good. That is why we say that in the time Jesus’ body was asleep, His soul went to trample out evil by his perfect goodness, thus the devil trembled with fear and opened the gates of hell where Jesus then trampled death for our salvation. He the was resurrected and ascended back to heaven. This is why his body was not there, it did not dissolve, it was awaken and made one again with his spirit, this is the resurrection of Jesus Christ our Lord and because of this, we now have eternal life everlasting. One can only die through acts of evil. We live only through God’s grace and not by any of our own works, because God can see what’s in our hearts, He know us for what we are.

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  41. Physicians and Patients Rock
    June 13, 2014 at 9:54 am

    I interned and worked at Atlanta’s number one trauma hospital and I have personally witnessed patients die from accepting blood transfusions and others who have not. Some continued to bleed despite tx and transfusion or their body rejected the transfusion, infections, extended hospital, not to mention it is very costly to have a transfusion etc.True to Dr. Fogelson’s statement, “I think back to my attending that had the hard line, and think perhaps he had a little too much of his own ego involved. He was deeply invested in his patient’s outcomes, and therefore would be personally injured if his patient died a death that he thought was preventable. I used to see this as noble, but in the end it was not the most effective physicianhood. His patients would have been better served if it he didn’t take their outcome so personally.” This is indeed true! Also a sad reality is that some well known physicians lack the knowledge of bloodless surgery and transfusion alternatives. A good and genuine physician who lacks the knowledge and/ or experience of bloodless surgery or who doesn’t personally feel comfortable performing the surgery and finds him or herself in the position of a JW patient, would refer the pt. to a colleague who was familiar w/ treating JW pt.’s (of course not considering trauma situations). Patients business is what brings in revenue in the medical field. One thing I have noticed w/ my working w/ JW pt.’s is that they really do want the best health care and they don’t refuse all tx. Of course w/ the best tx and even w/ a blood transfusion, a pt. could still expire. Respect the pt.’s wishes is my motto and even in the event of death, you know you did all you could in behalf of the pt. according to his or her wishes. Most of us have wishes we would like to be carried out in our behalf despite what others “feel”. If we expect our wishes to be carried out, let us not find ourselves forcing the opposite on our pt.’s. I also found it very interesting that the US military has adopted bloodless surgery treatment (take the time to research it yourself).

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